Pulmonary and CC Medicine Fellowship

The Pulmonary and Critical Care Medicine Fellowship Program at the University of Maryland is a three year combined pulmonary and critical care medicine training program. Details about specific features of our fellowship including the application process can be found by accessing the links on the left. The information on this page with the subheadings below provides an overview of our fellowship program.

Introduction

The Pulmonary and Critical Care Medicine Fellowship Program at the University of Maryland provides a comprehensive three year training program that utilizes the resources of our Division as well as other resources available to the School of Medicine. These resources include other Divisions within the Department of Medicine (Cardiology, Nephrology, and Infectious Diseases), other Departments within the School of Medicine (Anesthesiology, Radiology, Surgery, Neurology, and Pathology), and other facilities owned by the University of Maryland Medical System (UMMS) which provide specialized services, including the University of Maryland Midtown Medical Center and the University of Maryland R Adams Cowley Shock Trauma Center.

There are three primary facilities in which our fellows rotate during their clinical training: 1) the University of Maryland Medical Center (UMMC), our primary sponsoring institution and the location of the majority of our clinical rotations, 2) the Baltimore VA Medical Center, and 3) the University of Maryland Midtown Medical Center. The fellowship program is designed to provide the highest quality training in clinical pulmonary and critical care medicine, and to provide experience in the fundamentals of clinical and basic science research.

Clinical Training Program

The clinical training program is a busy program. Our fellows develop personally and professionally by acquiring expertise in the diagnostic evaluation and therapeutic intervention of a wide range of pulmonary and critical care diseases. There are more than sufficient numbers of pulmonary and critical care patients and pulmonary and critical care procedures. The major inpatient rotations at the University of Maryland Medical Center include the medical intensive care unit (MICU), the pulmonary medicine consult service, trauma anesthesiology, and the pulmonary medicine transplant service. The primary inpatient rotation at the Baltimore VA Medical Center is the combined MICU and pulmonary medicine consult service, and the primary inpatient rotation at the Midtown Medical Center is the medical-surgical ICU service.

The University of Maryland Medical Center has a 29 bed MICU, the VA Medical Center has a 10 bed MICU, and the Midtown Medical Center has an 18 bed ICU. In the MICUs, fellows learn the physiology, pathophysiology, diagnosis and therapy of critical illness and multi-system disease. On the pulmonary consultative services at UMMC and the VA, the fellows learn to provide expert pulmonary consultation in the diagnosis and treatment of a wide variety of respiratory conditions, and to learn the appropriate indications and contra-indications of the pulmonary specialty procedures, particularly bronchoscopy. Detailed understanding and accurate interpretation of pulmonary function tests (PFTs) are an integral part of these rotations. On the pulmonary medicine transplant service, the fellow learns appropriate indications and contraindications for lung transplantation, acquires knowledge into the pathophysiology of transplantation and its complications, and learns the appropriate use of specialty procedures in the evaluation and management of transplant patients.

In addition to the core inpatient rotations, fellows have the opportunity to participate in numerous pulmonary and critical care electives within the program, some of which are required for successful completion of the program. Critical care rotations other than the MICU include Neuro-Trauma, Multi-Trauma, and Select Trauma units at the University of Maryland R Adams Cowley Shock Trauma Center, the Neurosurgical ICU, the Cardiac Surgery ICU (CS-ICU), the General Surgical ICU (SICU), and the Critical Care Medicine Consult Service. These non-medical ICU rotations expose the fellows to a wide array of critical illnesses which are often not seen within the medical ICU , and provide the fellows a milieu to learn the principles of critical care within the respective disciplines. In addition to these critical care rotations, numerous pulmonary medicine electives are available for the fellows to meet their pulmonary requirements, and these include rotations in thoracic radiology, pulmonary physiology, pulmonary rehabilitation, pulmonary pathology, interventional bronchoscopy, thoracic surgery, sleep medicine, pulmonary hypertension, and pediatric pulmonary medicine. Read more about our clinical training program here.

The ambulatory experience within our program is comprehensive. The ambulatory experience is designed to instruct fellows in the approach to the pulmonary outpatient, including the integration of the history, physical examination, imaging, laboratory and pulmonary function data, and the subsequent synthesis of a coherent plan. The focus of patient care is on both the careful and complete evaluation of new respiratory complaints as well as appropriate and efficient follow-up of chronic conditions. Fellows care for pulmonary outpatients in continuity clinics seeing both new and established patients, and in subspecialty pulmonary clinics such as transplant medicine. At the Baltimore VA Medical Center, fellows see patients in the general pulmonary clinic and the outpatient Lung Mass clinic. The Lung Mass clinic gives the fellow substantial experience in the evaluation of patients with suspected intrathoracic malignancy, and provides further experience in the use of diagnostic bronchoscopy.

Fellows have the opportunity to participate in the care of patients within three other specialized areas within the Division: Sleep Medicine, Post-Acute Specialty Care/Pulmonary Rehabilitation, and Interventional Bronchoscopy. Sleep Medicine is led by a full time faculty member within our Division who is the Director of the Sleep Disorders Center of the University of Maryland. Fellows may choose to participate in the care of patients in the Sleep Medicine Clinic at the Midtown Medical Center, a multidisciplinary sleep disorders clinic which evaluates patients with a variety of respiratory and non-respiratory sleep disorders. Fellows on this rotation gain significant experience in the clinical approach to patients with sleep disorders, and gain significant understanding into the interpretation of overnight diagnostic polysomnography (PSG).

A second specialized rotation within our program is the Post-Acute Specialty Program (PASP) and Pulmonary Rehabilitation Program at the Midtown Medical Center campus. In the PASP program, fellows gain experience in the care of patients requiring continued care beyond the acute MICU setting. Fellows learn principles of care related to chronic ventilator management, management of longer-term tracheotomy care, and rehabilitation services. On the pulmonary rehabilitation service, fellows develop an understanding of how combining exercise training and behavioral and educational programs helps patients with pulmonary diseases control symptoms and improve day-to-day activities. They gain experience in the use of a team approach, working with physicians, nurses, respiratory therapists and physical therapists, psychologists, and dietitians.

A third specialized rotation within the Division is the Interventional Pulmonology Service. The Interventional Pulmonology (IP) program at UMMC is an integral part of our Division. The IP program offers a complete array of diagnostic, therapeutic, and palliative airway procedures, including bronchial thermoplasty, electromagnetic navigation bronchoscopy, rigid bronchoscopy, PDT, LASER therapy, APC, cryotherapy, and stenting. The IP service is also very active in the management of patients with pleural disease, with expertise in thoracic ultrasound guided assessment and interventions of the pleural space, medical thoracoscopy with parietal pleural biopsy and pleurodesis, pleural catheter placement (chest tube, small bore catheter, and implantable tunneled catheter), pleural manometry, and closed pleural biopsies. Our Fellows have numerous opportunities to gain exposure and experience in the realm of IP. The numerous opportunities for exposure and experience with all aspects of diagnostic and interventional bronchoscopy allow each fellow to develop a very good understanding of the field, and allow each fellow to make well-informed decisions about their areas of interest in their future careers.

Our Facilities

The three major facilities in which our fellows rotate are the University of Maryland Medical Center (UMMC), the Baltimore VA Medical Center, and the University of Maryland Midtown Medical Center. UMMC and the Baltimore VA are located on the University of Maryland, Baltimore campus in downtown Baltimore, and the Midtown Medical Center is located about one mile away from UMMC. UMMC is the principle hospital for our fellowship training program and for our Division. UMMC is a major tertiary and primary care facility with approximately 900 beds. The Medical Center cares for more than 30,000 inpatients and 500,000 outpatients each year, and additionally, serves as a major regional referral center for the most serious and complicated health problems in Maryland and the Mid-Atlantic region. All UMMC physicians are faculty of the University of Maryland School of Medicine.

The Fellowship benefits from the presence and location of the Baltimore VA Medical Center, a key component of both the clinical and research training programs. The VA Medical Center allows the fellows to care for numerous pulmonary and critical care patients, and have the opportunity to perform pulmonary and critical care procedures in a patient population different from that which is seen at UMMC. The VA medical center is on campus and directly connects to UMMC via a walking indoor bridge. This allows the Division to cover both hospitals with a single, fully integrated faculty and to have a single didactic conference series.

The University of Maryland Midtown Campus is the location of our 18 bed medical-surgical ICU. It is also the location of our Sleep Medicine Center for outpatient visits and overnight PSG, and the location of our Post-Acute Specialty Program and Pulmonary Rehabilitation Services. Our Division is responsible for attending and fellow coverage in the ICU, and provides fellows with an additional patient population experience different from UMMC and the VA. Read more about our facilities here.

Didactic Conferences

In addition to bedside faculty teaching, our Program and Division has comprehensive didactic conferences. The fellows are required for the majority of their fellowship experience to attend four weekly Division conferences:

Pulmonary Grand Rounds, a pulmonary and critical care evidence based conference, during which clinical and basic science topics in pulmonary and critical care diseases are presented with an evidence based approach;

Pulmonary and Critical Care Core Curriculum Conference, a fellow oriented conference into which Journal Club is incorporated;

Interdisciplinary Chest Conference, which is a clinical patient-based conference, in which fellows present clinical cases, a discussion of the relevant radiologic and pathologic materials, and a literature review of the illnesses that are highlighted in these cases; and

Multi-Departmental Critical Care conference, a critical care oriented didactic conference which comprehensively covers current critical care topics, and is presented by a wide range of faculty with expertise in critical care medicine.

Throughout the year, fellows intermittently have responsibilities for preparing and presenting at each of these four major conferences. As an academic institution, there are many additional conferences and lectures that the fellows are able to attend as their schedules allow. These include the Interdisciplinary Thoracic Oncology Conference, Thoracic Tumor Board, Medical Grand Rounds, Department of Medicine Clinicopathologic Conference, Translational Research Conference, and Inflammation Research Group Conference.

Research

Research and scholarly work is a major priority of our program. The research opportunities at the University of Maryland are numerous, and all faculty in our Division are involved in some manner with either basic science or clinical research efforts. Our Division Chief, Dr. Jeff Hasday, directs the University of Maryland Inflammation Research Group, a group of over 20 laboratories from the University of Maryland with common interests in mechanisms of inflammation, and this group conducts weekly seminars that have led to extensive collaborations within the School of Medicine. Fellows are expected to spend 12-16 months during the second and third years of fellowship participating in either basic science or clinical research projects under the guidance of the Division Faculty.

The goal of the research experience is to provide fellows the fundamentals of basic and clinical research within critical care units, inpatient or outpatient services, the pulmonary function laboratory, or the basic science laboratory. Clinical and/or laboratory research projects are complemented by didactic coursework, including a one-week course in clinical research offered by the Department of Epidemiology, and a two week course introducing the trainee to basic laboratory techniques. Fellows are expected to produce scholarly work as a result of their research efforts for presentation at national meetings and/or for publication in peer reviewed journals. For those fellows interested in pursuing an academic career, the Division and faculty will fully support any fellow desiring an additional year of fellowship training in order to meet their academic goals. We will provide didactic training and expertise to help support the fellow's research project, and will work towards obtaining extramural funding and improving their competitiveness for career development grants.

Mentored career development awards accessible to the University of Maryland include the individual K08 and K23 awards, the institutional K12 award, and a VA career development award. Our Division has access to a wealth of potential mentors and resources to support a transition to a faculty position. Additionally, the Department of Epidemiology has established a K30-funded clinical research training program that offers a Masters in Clinical Research for those fellows interested in pursuing an additional degree. Read more about our research training here.

Overall Goals

The overall goals of our fellowship program are to provide comprehensive clinical training and a broad range of research opportunities in order to create a strong foundation for a subsequent career in Pulmonary and Critical Care Medicine. The Division Chief and Fellowship Program Director are committed to achieving these goals. Both meet with each fellow regularly to discuss their current fellowship training experience and their career plans for the future. For those fellows who elect to pursue a career in clinical practice, this fellowship training program provides immense clinical experience along with exposure to clinical or basic science research. For those fellows who elect to pursue a career in academic medicine, this training will provide a springboard for transition to the next step in their academic career development.